The role of the personal trainer is changing. Traditionally, fitness professionals have helped clients reach their health and fitness goals by designing effective exercise programs, educating them about nutritional choices and motivating them to adhere to a consistent workout program. However, with almost 90% of personal training clients experiencing chronic or temporary injuries, personal trainers not only need to be well qualified in the field of corrective exercise, but also be aware of non-exercise related program variables that might affect their client’s musculoskeletal health (IDEA, 2013). This article will discuss how habitual postures, footwear choices, accessory habits, diet and stress can all exacerbate muscle and joint pain. It will also provide you with simple strategies to pass on to clients to help alleviate chronic aches and pains so they can continue, or return, to participating in their favourite activities.

Learning Objectives:

The reader will learn the importance of educating their clients about the non–exercise related aspects of their musculoskeletal health.

The reader will learn how habitual postures can cause muscle and joint pain, as well as tips and techniques they can suggest to clients to overcome these bad habits.

The reader will learn how shoes, orthotics, different accessories (such as phones and bags), dietary choices and stress can all affect a client’s musculoskeletal health, in addition to suggestions they can make to clients to help mitigate the negative effects.

Habitual Postures

Habitual postures (i.e., static positions people assume regularly and for extended periods of time) can exacerbate muscle and joint pain. While there are numerous static positions people assume, depending on their occupation or leisure activities, sitting and sleeping are two such habitual postures most of us engage in throughout the day.

Sitting

Profound advances in modern technology mean people spend increasingly more time in a seated position.

We sit almost all day long from the time we get up and eat breakfast, drive to and from work, answer emails, perform our job requirements, eat lunch and dinner and watch television in the evening. As a fitness professional, you understand better than anyone that the body will adapt to the stresses imposed upon it. Hence, the majority of people’s bodies are adapting to these seated postures by chronically flexing their hips and knees, rounding their shoulders, arching and rounding their spine and jutting their head forward (Kendall, 2005). These adaptations can wreak havoc on the musculoskeletal system and cause a whole host of symptoms from plantar fasciitis, Achilles tendinitis, patellofemoral disorders, hip bursitis, disc degeneration/disease, rotator cuff sprains and strains, carpal tunnel syndrome, headaches and temporomandibular joint disorder, to name a few (American Council on Exercise, 2010).

An obvious solution to helping clients overcome the problem of excessive sitting would be to suggest they don’t sit down so much. However, as modern society is based around an environment designed for sitting for long periods of time, this is not usually a practical suggestion and cannot be adhered to by clients long enough to result in any positive musculoskeletal changes. Therefore, it is important to educate your clients about the ill effects of sitting and provide them with several practical steps they can take throughout the day to minimise the negative impact this posture can have on their body.

To begin, you could propose that your clients eat breakfast or drink their morning coffee standing up. To encourage better driving posture, you can suggest that when they first get in the car to drive anywhere they sit up tall with good posture and adjust their rearview mirror so they can see clearly out the back of the car. If they find they cannot see clearly out of the mirror at any point later when they are driving (because they have slumped down in their seat) they can correct their posture and sit up tall again rather than adjust the mirror. This simple technique will give them a quick reminder to maintain a more upright driving posture (Price & Bratcher, 2010).

For most of your clients, a typical work day will revolve around sitting. Although the study of ergonomics suggests that certain seated postures are less harmful, the bottom line is that sitting for long periods of time is detrimental to the musculoskeletal system. To break up continuous stretches of sitting, encourage clients to do any of all of the following:

stand up throughout the day whenever possible

fidget while sitting to encourage a variety of seated postures

convert their workstation to a standup desk

use different chair types and alter computer heights frequently to provide some variability to the hips and spine.

With a little creativity and some built-in reminders, you can motivate your clients to assume an assortment of positions throughout the day to help them avoid the pattern overload of constantly remaining seated.

Sleeping

Habitual sleeping postures can also negatively affect your client’s musculoskeletal health. Sleeping on your stomach, for example, can overarch the lower back and twist the neck leading to pain and disc degeneration. Sleeping on your side can cause functional scoliosis, sacroiliac joint pain/dysfunction, shoulder and neck bursitis/pain. Sleeping on your back on the wrong type of mattress, and/or using a pillow of the wrong size, can also cause musculoskeletal adaptations that can increase pain and dysfunction.

Encourage clients to sleep on their back whenever possible – on a bed firm enough so neither the lower back nor thoracic spine sinks into the mattress. Sleeping on one’s back might not be as easy as it sounds, however, since many people have excessive lumbar lordosis (and therefore tight hip flexors) and this position may not be comfortable for them. To help make the position more tolerable (and promote better musculoskeletal alignment) suggest that the client places a wedge or pillow(s) under their knees to help posteriorly tilt the pelvis. (This will help keep the lumbar spine and pelvis nearer its neutral position) (McGill, 2002). You can also coach clients who sleep on their backs to choose a pillow thickness that puts their eyes in a position perpendicular to the ceiling. However, be sure that the pillow thickness is not so great that it pushes their head forward.

If you have clients that insist on sleeping on their sides, recommend that they place a pillow between their knees to help keep their top leg in line with the hip socket. The pillow they use for their head should be thick enough to keep their head/neck in line with their spine. Whenever possible, discourage clients from sleeping on their stomachs.

Shoes and Orthotics

Shoes

Undoubtedly, you’ve had clients ask your opinion on what type of shoes they should buy and whether or not they should use orthotics.There are many variables to consider when recommending the right shoes to ensure your client’s footwear choices don’t negatively impact their musculoskeletal health. For example, any shoe that has a higher heel than the toe (such as a running shoe) will tip your client forward. This forward tip can cause the posterior chain of muscles and other soft tissues to become overly-stressed as they work constantly to stop the body from toppling forward when standing or walking (Myers, 2001).

Another consideration is that most shoes taper inward from the mid-foot to the forefoot. This design does not match the anatomy of the foot as the toes need to spread out to help provide balance during all weight-bearing activities. Shoes that are narrow at the front prevent this vital foot function. Furthermore, many shoes that are marketed to provide a “natural” environment for the foot by providing a flat sole and space for the toes to spread out are typically very rigid and restrict the intrinsic movement of the foot needed to adapt to the terrain beneath. This type of footwear requires the ankle, knee and hip to work overtime to take up the slack for the rigidity of the shoe. As such, if clients want shoe recommendations, suggest that they gradually progress to wearing a more neutral-soled shoe that has plenty of space for the toes to spread out. Additionally, if clients have the requisite foot, ankle, hip and spine mobility, you might also recommend a more flexible-soled shoe.

Orthotics

Arch supports and orthotics are a valuable tool for clients needing a short-term crutch to support their feet as they overcome the underlying issues causing their aches and pains. However, as a fitness professional you should also be incorporating appropriate corrective exercises into clients’ programs to address their musculoskeletal dysfunction with the goal of eliminating the need for orthotics in the long run.

Accessories

You rarely see anyone these days not holding a phone in their hand or carrying a bag over their shoulder. These accessories, and the way they are used, can really do a number on musculoskeletal health. For example, talking on a cell phone can tip a person’s head to one side and cause a one-sided lateral flexion deviation of the neck. The head weighs 8 to 10 pounds and just one (1) inch out of optimal alignment in any direction doubles the effective weight of the head to the spine (Price & Bratcher, 2010). As a result, the spine and pelvis must shift out of alignment to try to counterbalance the increased effective weight of the head. Routinely carrying a handbag or briefcase on one side of the body can create a similar compensatory effect. The weight imbalance to one side of the body causes the hips and spine to shift laterally out of alignment, and also prevents spine rotation during gait as the arm holding the bag cannot swing freely to help rotate the torso. Even walking your dog with the leash held habitually in one hand can cause musculoskeletal adaptations, imbalances and resultant pain. To help mitigate problems from accessory overuse, suggest that clients use hands-free phone technology, use a backpack whenever possible (making sure it is strapped over both shoulders!) and alternate hands for holding the leash when walking their dog.

Diet

Dietary choices and habits can have a direct impact on the musculoskeletal system. Gluten, lactose, fructose, fatty/spicy foods and alcohol intolerances can inflame the human digestive tract and other organs such as the gallbladder, liver, colon and pancreas (Harker, 1998). These organs share connective tissue with many muscles in the body. Therefore, chronic inflammation of these structures can cause myofascial restrictions and adhesions throughout the body leading to muscle and joint pain. Coach your clients to be aware of those foods that irritate their system and help them to make nutritional choices that will not repeatedly aggravate their digestive organs.

Stress

When a person is under stress, the brain perceives the body to be under threat and reacts by activating its “flight or fight response.” Chronic psychological stress triggers this response regularly which can lead to a myriad of postural and musculoskeletal changes. If you are not happy in your job, for example, or are having relationship troubles, money worries and/or ongoing family issues, your body employs mechanisms to protect yourself from these perceived threats. These responses can include tensing of the jaw, tightening of the abdominals, restricting breathing and rounding of the shoulders, all of which can lead to chronic muscle and joint pain (Hanna, 1988). Making clients aware of this mind-body connection can prompt them to develop better coping skills, which in turn, can help moderate the negative musculoskeletal effects of chronic stress.

Conclusion

Postural assessments and strategic corrective exercises that address underlying musculoskeletal imbalances are generally thought to be the only way to help clients alleviate joint and muscle pain. Yet, an often overlooked element that can add tremendous value to your corrective exercise programming is educating clients about important, non-exercise related aspects of their daily lives that may also be contributing to their problems, such as those discussed in this article. Making clients aware of the potential impact of their non-exercise activities, and providing them with simple solutions to incorporate daily, can result in greater success for your clients and set you apart as an industry professional.

References:

American Council on Exercise. 2010. ACE Personal Trainer Manual (Fourth Edition). American Council on Exercise.

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Justin Price (MA) is a Corrective Exercise Specialist with 20 years of experience in the field of health and fitness. His expertise lies in assessing and correcting neuromuscular and structural imbalances that cause chronic pain. He has helped individual athletes, professional sports teams, people with injuries, people with disabilities, children, seniors and others to improve their lives through his unique approach to exercise and human movement analysis. His revolutionary system for working with people who experience muscle and joint pain is called The BioMechanics Method™. In addition to working with clients in his San Diego-based clinic, The BioMechanics, Justin also shares his assessment and exercise Method with other health and fitness professionals through a series of educational courses (www.thebiomechanicsmethod.com). To date, components of The BioMechanics Method™ are in use in over 20 countries and are featured as the basis of the postural assessment portion of the Integrated Fitness Training™ model (ACE-IFT) created by The American Council on Exercise.

Justin is a published author, professional speaker and consultant to the media. He is the 2006 IDEA Personal Trainer of the Year, an IDEA Health and Fitness Association Committee Member and their national media spokesperson. He is also a subject matter expert on corrective exercise and content provider for BOSU, TRX, Power Systems, ACE, NSCA, PTA Global, and PTontheNET.